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his lack of insight into such events, there is little reason to
believe that such behaviour will discontinue. Additionally,
Sharon’s hopeful attitude that he will return to his previous
abilities conveys her unrealistic beliefs towards Casper,
making such a statement even more questionable.
The role of the narrator is to encourage multiple voices to
be heard and be involved in the decision-making process
rather than to focus on reaching an endpoint (Jones, 1999).
Considering the first-person narrative is to be privileged
(McCarthy, 2014), it is essential that Casper’s perspective
be uncovered before reaching a decision. This should
be the first step undertaken. Understanding the stories
of those involved does point to areas where particular
care and counselling should be provided. For example,
informing Sharon about her and her son’s rights to refuse
the medication and helping them gain a more realistic
understanding of what can be expected for Casper and his
recovery present as pressing issues.
Student’s reflection on the two
approaches
The narrative approach encourages us to delve into the
emotional and psychological landscapes of clients and their
families and in doing so we are better able to identify how
to work with them (Nelson, 2014). Because this activity
involved a simulated interview, as the student in this
exercise, I was able to actually listen to Sharon and console
her as she discussed the recent difficulties of her son since
the accident. This helped me to appreciate the way
emotions, stories and perspectives of those involved can
shape the way we may respond to an ethical dilemma.
They interplay with the principles within the Code of Ethics
(2010) and complicate the situation as we try to weigh up
the outcomes of different responses to the dilemma as they
influence those involved. In contrast, the principles-based
approach guides our reasoning so that the key themes of
an ethical dilemma are logically and thoughtfully considered
principle by principle. Our personality and predispositions
may make one approach more appealing than another;
however, this article stands as evidence for the application
of either of these approaches, as each promotes a depth of
analysis and understanding beyond our own personal
judgements. Ideally though, a combination of both
approaches should be attempted as it allows us to come to
a more comprehensive understanding of the needs and
considerations of our clients and their family and will allow
us to better fulfil the ethical standards of our practice. This
is a key learning objective for student SLPs ahead of
graduation, and a challenge for both novice and
experienced clinicians as they navigate a range of ethical
dilemmas in clinical practice.
In the classroom, ethics instruction can appear devoid
of real-life application. As the student in this activity, I came
to understand the use of these frameworks to structure
my thinking so that multiple perspectives and issues can
be clearly and carefully deliberated. Halfway through
my course, I now feel equipped with the tools that will
allow me to provide a service that reflects a higher level
of ethical reasoning than if addressed purely on my own
moral accord. These frameworks do not only provide
students with a structure to address ethical dilemmas, but
can also enhance the quality of care provided by speech
pathologists of all levels of expertise in their clinical practice.
References
Beauchamp, T. L., & Childress, J. F. (2001). Principles of
biomedical ethics. New York: Oxford University Press.
Helen Corbould obtained a Bachelor of Arts with a double major
in psychology at the University of Western Australia and is currently
completing her final year of a Masters of Speech Language
Pathology at the University of Sydney. Andy Smidt is a speech
pathologist and lecturer at the University of Sydney. Her research
and teaching interests include lifelong disability and AAC, ethics
and evidence-based practice. Emma Power is a speech
pathologist and lecturer at the University of Sydney. Her research
and teaching interests include knowledge transfer and exchange
(KTE) and neurogenic cognitive-communication disorders.
Correspondence to:
Dr Andy Smidt
University of Sydney
phone: (02) 9351 9008
email: